1. Mehmet Cengiz Colak, MD, Nevzat Erdil, MD, Olcay Disli, MD, Ercan Kahraman, MD, And

1. Mehmet Cengiz Colak, MD, Nevzat Erdil, MD, Olcay Disli, MD, Ercan Kahraman, MD, and Bektas Battaloglu, MD. Anomalous Origin of the Left Coronary Artery from the Right Coronary Sinus. Ann Thorac Cardiovasc Surg 2012; 18: 548–550

DISCUSSION

Anomalous coronary arteries do not appear to be associated with an increased risk for development of coronary atherosclerosis (7literature Gowda RM, Chamakura SR, Dogan OM, et al. Origin of left main and right coronary arteries from right aortic sinus of Valsalva. Int J Cardiol 2003; 92: 305-6.). Some patients with anomalous coronary arteries have symptoms of angina pectoris due to atherosclerosis.

2. Filippo Prestipino*, Mario Lusini, Cristiano Spadaccio and Massimo Chello. Severe stenosis of left coronary artery originating from right sinus of Valsalva treated with off-pump coronary artery bypass surgery. Interactive CardioVascular and Thoracic Surgery 19 (2014) 347–349

INTRODUCTION

The incidence rate of coronary anomalies is generally reported to be about 1% (ranging from 0.6 to 1.3% in angiographic series) [1–3]. The anomalous origin of the left coronary artery from the opposite sinus of Valsalva (ACAOS) is an uncommon finding.

[1] Vincelj J, TodorovićN, MarusićP, PuksićS. Anomalous origin of the left coronary artery from the right sinus of Valsalva in a 62-year-old woman with unstable angina pectoris: a case report. Int J Cardiol 2009;142:e35–7.

[2] Latsios G, Tsioufis K, Tousoulis D, Kallikazaros I, Stefanadis C. Common origin of both right and left coronary artery from the right sinus of Valsalva. Int J Cardiol 2008;128:e60–1.

[3] Kannam HC, Satou G, Gandelman G, DeLuca AJ, Belkin R, Monsen C et al. Anomalous origin of the left main coronary artery from the right sinus of Valsalva with an intramural course identified by transesophageal echocardiography in a 14 year old with acute myocardial infarction. Cardiol Rev 2005;13:219–22.

CASE REPORT

A 49-year-old man was admitted to the Cardiology Department of our institution with a new onset of chest pain. An electrocardiogram showed signs of anterior and lateral acute ischaemia, a chest X-ray did not show signs of pulmonary overload and laboratory findings showed a mild increase in troponin T levels (0.6 μg/l, with normal values <0.03 μg/l). A coronary angiogram showed an anomalous left main artery arising from the right Valsalva sinus, presenting with a long and severe stenosis; this artery crossed the aortic root anteriorly, generating the left anterior descending artery (LAD), circumflex artery and a small intermediate branch.The coronary artery originating from the left Valsalva sinus appeared to be hypoplastic; the LAD demonstrated another nonsignificantnonsignificant stenosis in its medial tract. The first obtuse marginal branch of the circumflex artery showed a parietal irregularity, and the right coronary artery was dominant without significant wall abnormalities. An intravascular coronary ultrasound examination was performed, and it indicated that, in addition to the long stenosis shown on the angiogram, a circumferential fibrolipidic plaque was also present.

DISCUSSION

Generally, the trans-septal, intraseptal, anterior and retro-aortic types are asymptomatic because they do not provoke a reduction in myocardial perfusion upon physical effort; therefore, they might be considered benign. A very different situation occurs for the interarterial type, which frequently presents with syncope or aborted sudden cardiac death. Other symptoms or clinical presentations include the presence or development of angina, acute myocardial infarction and ventricular tachycardia [4].

[4] Liberthson RR, Dinsmore RE, Fallon JT. Aberrant coronary artery origin from the aorta. Report of 18 patients, review of literature and delineation of natural history and management. Circulation 1979;59:748–54.

However, percutaneous coronary angioplasty and coronary surgery are indicated in symptomatic patients.

3. Paolo Angelini, MD. Coronary Artery Anomalies An Entity in Search of an Identity. Circulation. 2007;115:1296-1305.

Incidence of Coronary Artery Anomalies

Eventually, the ischemic mechanisms of CAAs9,12–14 and the incidence of these anomalies in the normal human population were addressed in autopsied patients and coronary angiography populations.10

10. Angelini P, Villason S, Chan AV, Diez JG. Normal and anomalous coronary arteries in humans. In: Angelini P, ed. Coronary Artery Anomalies: A Comprehensive Approach. Philadelphia: Lippincott Williams & Wilkins; 1999:27–150.

In one of the few prospective analyses to involve strict diagnostic criteria, which was performed in a continuous series of 1950 patients studied by coronary angiography, our group found that CAAs had a global incidence of 5.64% (Table 3), which is much higher than usually reported. Particularly noteworthy were the 0.92% incidence of anomalous origination of the RCA from the left sinus and the 0.15% incidence of anomalous origination of the left coronary artery from the right sinus (for a total incidence of 1.07% for ACAOS).10

4. Jian Dai, Osamu Katoh, Eisho Kyo, Xun Jie Zhou, Takafumi Tsuji, Satoshi Watanabe, Hidefumi Ohya. Percutaneous Intervention in a Patient with a Single Coronary Artery Arising from the Right Coronary Sinus of Valsalva. Hellenic J Cardiol 2014; 55: 427-432

Discussion. A single coronary artery (SCA) is a rare coronary artery anomaly, particularly in the absence of structural heart disease. According to the modified Lipton’s classification of SCA, Yamanaka reported that the incidence of the R-I subtype was 0.0008% in a large series of 126,595 patients undergoing coronary angiography (2).

2. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet Cardiovasc Diagn. 1990; 21: 28-40.

5. Jlenia Marchesini,1 Gianluca Campo,1 Riccardo Righi,2 Giorgio Benea,2 Roberto Ferrari1. Coronary artery anomalies presenting with ST-segment elevation myocardial infarction.iniactice 2011; volume 1:e107